The pattern of steroid sensitivity and steroid resistance in childhood idiopathic nephrotic syndrome: A 5 year retrospective observational descriptive study in a South East Nigerian tertiary hospital

Abstract

Background/Aim: Nephrotic syndrome is the most common glomerular disease of childhood. Majority of the idiopathic cases frequently respond to steroid therapy and are regarded as steroid‑sensitive nephrotic syndrome. Several studies have reported a change in this usual pattern to steroid‑resistant nephrotic syndrome in Nigerian children. This study aimed to determine the pattern of steroid sensitivity and steroid resistance in childhood idiopathic nephrotic syndrome seen at a tertiary hospital in Enugu, south‑east Nigeria. Materials and Methods: A retrospective study conducted in children with idiopathic nephrotic syndrome seen at the University of Nigeria Teaching Hospital, Ituku‑Ozalla Enugu, over 5 years (from 2016 to 2020). The demographic variables, clinical data, and histopathological pattern were documented. Renal biopsies were studied by light microscope only. Results: Of a total of 150 patients, 105 (70%) were males, while 45 (30%) were females. Ninety six (64%) were aged 1‑10 years. Fifty four (36%) were aged 11‑18 years. Forty eight (32%) were aged 1‑5 years. Mean age was 8.67 ± 4.69 years. One hundred and six (71%) initially had steroid‑sensitive nephrotic syndrome; 12 (11.3%) and seven (6.6%) later became frequent‑relapsers and steroid‑dependent, respectively. Forty four (29.3%) had steroid‑resistant nephrotic syndrome. Sixty eight had renal biopsy; the most common indication being steroid‑resistance. The most common histological pattern was focal segmental glomerulosclerosis seen in 63.2% of these patients. Only four (9%) had renal transplant. Conclusion: Although the prevalence of steroid‑sensitive nephrotic syndrome is higher in this clime, there is a rising incidence of steroid‑resistant pattern attributed to incident cases of focal segmental glomerulosclerosis.